{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:24:39Z","timestamp":1783463079825,"version":"3.55.0"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ACR Open Rheumatology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Immunocompromised individuals with rheumatic conditions have heightened risk of tuberculosis (TB) infection, reactivation, and severe disease. Patients with social risks are especially vulnerable. After an alert of increased TB rates among individuals experiencing homelessness in Massachusetts, we leveraged the existing social risk screening infrastructure to identify those at highest risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified patients with rheumatic conditions receiving immunosuppressive or immunomodulatory medications and recent housing instability from the electronic health records (EHRs) of a multihospital medical system. We notified these patients\u2019 rheumatologists and provided latent TB and TB symptom screening information. We tracked EHR documentation, orders, and laboratory results following this alert.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010three patients with rheumatic conditions experienced housing instability. Of these, 23 (70%) patients cared for by 17 rheumatologists were prescribed \u22651 immunosuppressive or immunomodulatory medications. Following the alert, three (13%) patients had EHR documentation of symptom screening, one provider responded that their patient was not homeless, and one ordered an interferon\u2010gamma release assay (\u201cT\u2010SPOT\u201d). After the reminder, seven (30%) T\u2010SPOT tests were ordered, five (22%) patients had EHR documentation of symptom review at their subsequent rheumatology appointment, and four (18%) patients were messaged by their rheumatologists about their TB risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The existing rheumatology\u2010based social risk factor screening infrastructure facilitated a rapid response to a relevant public health concern. Rheumatologists\u2019 responses varied, possibly due to increased clinical stressors with limited support. Despite challenges to reaching patients with housing instability, many actions were taken. Efforts to prompt regular TB screening of patients with these vulnerabilities are underway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr2.90062","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T13:36:35Z","timestamp":1778592995000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Leveraging Social Risk Factor Screening Infrastructure in Rheumatology Clinics to Respond to Rising Rates of Tuberculosis Among Individuals Experiencing Homelessness"],"prefix":"10.1002","volume":"8","author":[{"given":"Rebecca","family":"Summit","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan B.","family":"Tierney","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"},{"name":"Harvard Medical School  Boston Massachusetts"},{"name":"Massachusetts Department of Public Health  Boston"},{"name":"Division of Global Health Equity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taussia","family":"Boadi","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Green","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karli","family":"Retzel","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Bills","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3953-845X","authenticated-orcid":false,"given":"Nancy A.","family":"Shadick","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"},{"name":"Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8951-2296","authenticated-orcid":false,"given":"Leah","family":"Santacroce","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara R.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts"},{"name":"Rheumatology Unit, Department of Medicine Massachusetts General Hospital  Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4980-9770","authenticated-orcid":false,"given":"Candace H.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Inflammation, and Immunity, Department of Medicine Brigham and Women's Hospital  Boston Massachusetts"},{"name":"Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"World Health Organization.Social determinants of health. Accessed May 16 2025.https:\/\/www.who.int\/health-topics\/social-determinants-of-health#tab=tab_1."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac613"},{"issue":"9","key":"e_1_2_7_4_1","article-title":"Implementation of a rheumatology\u2010based social determinants of health screening program to uncover and address needs in a multihospital health care system [abstract]","volume":"75","author":"Feldman C","year":"2023","journal-title":"Arthritis Rheumatol"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.716857"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","DOI":"10.1177\/1759720X20930116","article-title":"Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors","volume":"12","author":"Evangelatos G","year":"2020","journal-title":"Ther Adv Musculoskeletal Dis"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223335"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01245-2015"},{"key":"e_1_2_7_9_1","unstructured":"Boston Health Care for the Homeless Program.Our mission and work: BHCHP. Accessed May 16 2025.https:\/\/www.bhchp.org\/about\/our-mission-work\/."},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2021-001362"},{"key":"e_1_2_7_11_1","unstructured":"Centers for Disease Control and Prevention.Social determinants of health (SDOH). Accessed June 18 2024.https:\/\/www.cdc.gov\/about\/priorities\/why\u2010is\u2010addressing\u2010sdoh\u2010important.html#cdc_generic_section_2\u2010why\u2010is\u2010addressing\u2010sdoh\u2010important\u2010for\u2010cdc\u2010and\u2010public\u2010health"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.08.024"},{"key":"e_1_2_7_13_1","unstructured":"HealthIT.gov.Social needs screening among non\u2010federal acute care hospitals. Accessed September 1 2025.https:\/\/www.healthit.gov\/data\/data-briefs\/social-needs-screening-among-non-federal-acute-care-hospitals-2022."},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001754"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2019.8267"},{"key":"e_1_2_7_16_1","unstructured":"Centers for Disease Control and Prevention.Tuberculosis risk factors. Tuberculosis (TB). Accessed May 16 2024.https:\/\/www.cdc.gov\/tb\/risk-factors\/index.html"}],"container-title":["ACR Open Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr2.90062","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr2.90062","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr2.90062","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T21:58:15Z","timestamp":1783461495000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr2.90062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/acr2.90062"],"URL":"https:\/\/doi.org\/10.1002\/acr2.90062","archive":["Portico"],"relation":{},"ISSN":["2578-5745","2578-5745"],"issn-type":[{"value":"2578-5745","type":"print"},{"value":"2578-5745","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2026-03-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e90062"}}